Medical Care - Hospice Services

Hospice Services

Forms

The Medical Care Unit is responsible for providing prior authorization for Hospice services.  General instructions and important points are outlined below.  Forms, provider handbooks, and more information is available through the links to the right. 

To obtain prior authorization and payment for hospice services:

Please complete the Hospice Intake Form completely, clearly, and legibly, including the Medicaid participant’s:

• Name
• Date of birth
• Correct Medicaid identification number
• Hospice election form: Signed by the participant
• Physician Certification: Signed by the physician
• Hospice plan of care: Signed by the physician
• History and physical

Once a Medicaid participant elects to receive hospice services, all documentation must be received within five business days. 

When a participant revokes their hospice election or passes away, the hospice agency must notify Medicaid within five business days by faxing a copy of the original intake form with the revocation or death date documented.

The procedure code that you use to bill Medicaid must be the same as the one that you use on the patients chart or your claim will be denied. The ICD-9 diagnosis code for the terminal illness must also match,

Remember that CMS requires a Hospice agency to notify Medicaid when a participant is eligible for Medicare.

For more information contact (208) 364-1818.

Hospice Intake

Important Information

Provider Handbooks

Fee Schedules

Medicaid Rules (Section 235)

Information Releases

MA08-19 Hospice Rates

Resources and Links

Idaho State Hospice and Palliative Care Organization